The timing of academic difficulties among maltreated and nonmaltreated children.

OBJECTIVE: In this study we examined the relationship between child maltreatment and the timing of academic difficulties. METHOD: This study uses survival analysis to investigate the timing of risk of experiencing an academic difficulty for the first time. Three types of academic difficulties were examined-grade repetitions, poor English grades, and poor math grades. The sample included approximately 300 maltreated and 300 nonmaltreated children aged 5-18. RESULTS: Maltreated children displayed greater risk than nonmaltreated children of repeating a grade and receiving a poor English and mathematics grade for the first time across most elementary years. Maltreated and nonmaltreated children share the same peaks in risk: first grade for their first grade repetitions and kindergarten for their first poor English and math grade. The best-fitting discrete time hazards models suggested underlying temporal patterns of risk vary according to the type of academic difficulty. For instance, maltreated children were at substantially higher risk than nonmaltreated children of repeating kindergarten and first grade. From second through sixth grade, maltreated and nonmaltreated children were indistinguishable in their risk of repeating a grade for the first time. In contrast, discrete-time hazards modeling showed that while the absolute risk of receiving a poor English or mathematics grade changes across the elementary years, the relative risk by maltreatment status does not. CONCLUSIONS: While maltreated and nonmaltreated children share the same peaks in risk, the relative risk changes across time for grade repetitions but not for the first occurrence of a poor English or mathematics grade. In summary, this study highlights the importance of time in understanding the relationship between child maltreatment and academic difficulties.     

Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children

This study used latent growth modeling to investigate longitudinal relationships between self-system processes and depressive symptoms among maltreated (n = 142) and nonmaltreated children (n = 109) aged 6-11 years. On average, self-esteem and self-agency increased and depressive symptoms decreased over time. Multivariate growth modeling indicated that, regardless of gender, physical abuse was negatively related to initial levels of self-esteem, and physical abuse and physical neglect were positively associated with initial levels of depressive symptoms. Emotional maltreatment was predictive of changes in self-esteem and changes in depressive symptoms. Initial levels of self-esteem were negatively associated with initial levels of depressive symptoms. The findings contribute to enhancing our understanding of the developmental processes whereby early maltreatment experiences are linked to later maladjustment.     

Dissociation in maltreated versus nonmaltreated preschool-aged children.

OBJECTIVE: Dissociation is linked to the experience of child maltreatment for adults and for school-aged children. The goals of the current paper were: First, to extend existing research and examine the link between child maltreatment and preschool-aged children; and second, to examine which subgroups of maltreated preschoolers are most likely to evidence dissociation. METHOD: A well-validated measure of dissociation in children, The Child Dissociative Checklist (CDC; Putnam, Helmers, & Trickett, 1993), was utilized in a sample of low SES maltreated and nonmaltreated preschoolers (N = 198). A measure of internalizing and externalizing symptoms was also utilized. The maltreated children were assessed for sexual abuse, physical abuse, neglect, and also for severity, chronicity, and multiple subtypes of maltreatment. RESULTS: The sexually abused, physically abused, and neglected groups each demonstrated more dissociation than did the nonmaltreated group. Dissociation in the clinical (psychopathological) range was associated with physical abuse. Moreover, maltreatment severity, chronicity, multiple subtypes, and internalizing and externalizing symptomatology were each related to dissociation. CONCLUSIONS: Child maltreatment is a factor in dissociation in preschool-aged children as it is in older children and in adults. Sexual abuse, physical abuse, neglect, severity, and chronicity are all implicated. Developmentally sensitive interventions that look beyond comorbidity with behavioral symptoms for dissociative preschool-aged children are needed.     

The prevalence of social maladjustment among school-age children

PL 94-142 mandates that students who are seriously emotionally disturbed be provided with a free and appropriate public education. Embedded in the federal definition of serious emotional disturbance is a clause that excludes socially maladjusted students from the diagnostic category. Although socially maladjusted children may therefore not receive special education services, their presence in the schools may have implications for society and particularly for the educational system. However, there is little data concerning the prevalence of socially maladjusted students in the schools. The purpose of this study was to investigate the prevalence of social maladjustment in two rural/suburban school systems in the southeastern United States. Results of the study indicate that the percentage of students reported as exhibiting characteristics of social maladjustment is sufficiently high to indicate that services beyond special education may be necessary to meet their educational and social needs.     

Experiences in day care and social competence among maltreated children

The experience of 39 preschool-age maltreated children from 13 child care facilities was examined to determine the extent to which the children's social development was related to the quality of day-care service. Maltreated children assigned by the Arkansas Department of Social Services to three different types of child care facilities were observed: specialized day-care programs, regular day-care centers and family day homes. The children scored below average in intelligence and were rated by their parents as displaying higher than normal rates of disturbed behavior. While no comparison group of non-maltreated children was included in the study, observations of the maltreated children in the child care setting revealed substantially more positive than negative social behavior. The children were reasonably effective in interacting with adult caregivers in day care. The maltreated children were also productive in most encounters with peers. Ratings of the quality of care received in day care were significantly correlated with the children's social competence in child care. Aspects of social behavior in maltreated children were related to the organization of the program, the physical facilities, traits of the caregiver, and caregiver expectations for the children.     

Memory, maternal representations, and internalizing symptomatology among abused, neglected, and nonmaltreated children

A depth-of-processing incidental recall task for maternal-referent stimuli was utilized to assess basic memory processes and the affective valence of maternal representations among abused ( N  = 63), neglected ( N  = 33), and nonmaltreated ( N  = 128) school-aged children (ages 8–13.5 years old). Self-reported and observer-rated indices of internalizing symptoms were also assessed. Abused children demonstrated impairments in recall compared to neglected and nonmaltreated children. Although abused, neglected, and nonmaltreated children did not differ in valence of maternal representations, positive and negative maternal schemas related to internalizing symptoms differently among subgroups of maltreated children. Valence of maternal schema was critical in differentiating those with high and low internalizing symptomatology among the neglected children only. Implications for clinical intervention and prevention efforts are underscored.     

Racial/ethnic differences in Medicaid expenditures on psychotropic medications among maltreated children

This study quantifies racial/ethnic differences in Medicaid expenditures on psychotropic drugs among a national sample of children with suspected maltreatment. We linked 4,445 child participants in the National Survey of Child and Adolescent Well-Being (NSCAW) – consisting of children investigated for suspected abuse and neglect – to their Medicaid claims obtained from 36 states. We used propensity score matching to construct a comparison group of children without known child welfare involvement, and estimated two-part generalized linear models to examine differences in annual psychotropic drug expenditures per child between children of different races/ethnicities. When compared to a matched sample of children, African American and Latino children incur $292 and $144 less expenditures on psychotropic drugs, respectively, than white children. Among NSCAW children alone, African American children display $614 less spending on psychotropic drugs when compared to white children. Racial/ethnic differences in expenditures on psychotropic drugs occur among all children on Medicaid, but the differences are especially pronounced among African American children in contact with the child welfare system. These findings demonstrate that policymakers will need to pay special attention to the needs of children of color as Medicaid expansions proceed nationwide.     

Enhancing attachment organization among maltreated children: results of a randomized clinical trial

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.     

True and false memories in maltreated children

Differences in basic memory processes between maltreated and nonmaltreated children were examined in an experiment in which middle-socioeconomic-status (SES; N = 60), low-SES maltreated (N = 48), and low-SES nonmaltreated (N = 51) children (ages 5-7, 8-9, and 10-12 years) studied 12 Deese-Roediger-McDermott lists. Using recall and recognition measures, the results showed that both true and false memories increased with age and, contrary to some speculation, these trends did not differ as a function of maltreatment status. However, there were differences in overall memory performance as a function of SES. These results are discussed in the broader framework of children's memory development and the effects of the chronic stress associated with child maltreatment on basic memory processes.     

Recognition of facial emotions among maltreated children with high rates of post-traumatic stress disorder

OBJECTIVE: The purpose of this study is to examine processing of facial emotions in a sample of maltreated children showing high rates of post-traumatic stress disorder (PTSD). Maltreatment during childhood has been associated independently with both atypical processing of emotion and the development of PTSD. However, research has provided little evidence indicating how high rates of PTSD might relate to maltreated children's processing of emotions. METHOD: Participants' reaction time and labeling of emotions were measured using a morphed facial emotion identification task. Participants included a diverse sample of maltreated children with and without PTSD and controls ranging in age from 8 to 15 years. Maltreated children had been removed from their homes and placed in state custody following experiences of maltreatment. Diagnoses of PTSD and other disorders were determined through combination of parent, child, and teacher reports. RESULTS: Maltreated children displayed faster reaction times than controls when labeling emotional facial expressions, and this result was most pronounced for fearful faces. Relative to children who were not maltreated, maltreated children both with and without PTSD showed enhanced response times when identifying fearful faces. There was no group difference in labeling of emotions when identifying different facial emotions. CONCLUSIONS: Maltreated children show heightened ability to identify fearful faces, evidenced by faster reaction times relative to controls. This association between maltreatment and atypical processing of emotion is independent of PTSD diagnosis.     

A longitudinal investigation of protective factors for bereaved maltreated youth

BackgroundMaltreated youth are at an elevated risk for the development of problem behaviors. Coping with the death of a family member or close friend during adolescence, referred to as bereavement, is a stressful event that could potentiate risk linked to maltreatment. However, developmental research suggests that youth adjustment is a product of multiple risk and protective factors. Although maltreated youth who experience loss may be particularly vulnerable to behavior problems, personal and contextual factors may attenuate or exacerbate youths’ risk for internalizing and externalizing psychopathology.ObjectiveThe overarching goal of this study is to examine individual, family, and community-level protective factors for maltreated youth who experience bereavement. Specifically, we aim to examine the effect of age 12 bereavement on age 16 internalizing and externalizing psychopathology, and to investigate the moderating role of multi-level protective factors at ages 14 and 16.MethodsThe study consisted of a sample of 800 youth (52.4% female, 45.1% African-American) drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), collected from 1998 to 2011.ResultsMaltreated youth who experienced significant loss were at increased risk for externalizing symptoms, compared to non-bereaved maltreated youth (β = 0.085, p < .05). Individual future orientation (β = 0.103, p < .05) family future orientation (β = −0.120, p < .05), parental monitoring (β = −0.123, p< .01), and neighborhood collective efficacy (β = −0.126, p < .01) each significantly moderated the association between bereavement and externalizing symptoms.ConclusionsThese results have implications for future interventions aimed towards reducing problem behaviors in adolescents with a history of child maltreatment and who experience bereavement.     

Truth induction in young maltreated children: the effects of oath-taking and reassurance on true and false disclosures

OBJECTIVE: Two studies examined the effects of the oath or reassurance ("truth induction") on 5- to 7-year-old maltreated children's true and false reports of a minor transgression. METHODS: In both studies an interviewer elicited a promise to tell the truth, reassured children that they would not get in trouble for disclosing the transgression, or gave no instructions before questioning the child. In Study 1, children were encouraged to play with an attractive toy by a confederate, who then informed them that they might get in trouble for playing. In Study 2, a confederate engaged children in play, but did not play with the attractive toy. RESULTS: In Study 1, the oath and reassurance increased disclosure among children who would qualify as competent to take the oath. In Study 2 neither the oath nor reassurance increased false reports among children who would qualify as competent, whether yes/no questions or tag questions were asked. Among non-competent children, reassurance (but not the oath) increased false reports. Children were more likely to accuse the confederate of the transgression than to implicate themselves. CONCLUSIONS: The results suggest that a promise to tell the truth may increase true disclosures without increasing false allegations. Reassurance that specifically mentions the target activity also increases true disclosures, but may increase acquiescence among some children. PRACTICE IMPLICATIONS: A child-friendly version of the oath may be a useful addition to child interviews.     

Perceived and actual academic competence in maltreated children

OBJECTIVE: The aims were twofold: 1) to determine whether maltreated and nonmaltreated children differed in the accuracy of their self-assessments of academic achievement; and 2) to determine whether discrepancies between perceived and actual academic competence were related to perceptions of social support from mothers, teachers, and peers. METHOD: A sample of 195 maltreated children known to a state protective service agency was compared to a control group of 179 nonmaltreated children. The groups were matched on child's gender, age, ethnicity, and birth order; socioeconomic ranking of neighborhood; and family structure. RESULTS: Although maltreated children had significantly lower achievement scores than did nonmal-treated children, the two groups did not differ on perceived academic competence. With regard to discrepancies between perceived and actual competence, maltreated children were more likely than nonmaltreated children to overestimate their level of competence, particularly for reading and arithmetic. Overall, children who reported low maternal support were more likely to overestimate reading competence than were those who reported average or high maternal support. When maltreatment status was considered, maltreated children with low support seemed likely to overestimate abilities, whereas nonmaltreated children with low support seemed likely to underestimate competence. CONCLUSIONS: Maltreated children may overestimate their academic abilities in order to compensate for self-perceptions of low self-worth. Efforts to improve academic performance in maltreated children should focus not only on increasing academic skills but also on enhancing self-esteem.     

School connectedness and high school graduation among maltreated youth

Maltreated youth have higher rates of school dropout than their non-maltreated peers. School connectedness is a modifiable predictor of school success. We hypothesized maltreated youth’s school connectedness (supportive relationships with adults at school and participation in school clubs) would be positively associated with high school graduation. We included youth with at least one Child Protective Services (CPS) report by age twelve from Longitudinal Studies of Child Abuse and Neglect, a prospective cohort study. Participation in extracurricular activities and adult relationships reported at age 16, high school graduation/General Education Development (GED) status reported at age 18, and demographics were provided by youth and caregivers. Maltreatment data were coded from CPS records. The outcome was graduation/receipt of GED. Multivariable logistic regressions examined the association between school connectedness and graduation/receipt of GED, controlling for confounders. In our sample of 318 maltreated youth, 73.3% graduated. School club was the only activity with a statistically significant association with graduation in bivariate analysis. Having supportive relationships with an adult at school was not significantly associated with graduation, though only 10.7% of youth reported this relationship. Maltreated youth who participated in school clubs had 2.54 times the odds of graduating, adjusted for study site, gender, poverty status, caregiver high school graduation status, and age at first CPS report (95% CI: [1.02, 6.33]). Few maltreated youth reported relationships with adults at school, and additional efforts may be needed to support these vulnerable youth. School club participation may represent an opportunity to modify maltreated youth’s risk for school dropout.     

Incarcerated mothers' perceptions and interpretations of their fatally maltreated children

Fatally maltreated children are an elusive component in the complex interaction that has led to their premature deaths. Retrospective research with women imprisoned for fatal child maltreatment indicated recurring themes of maternal interpretations of their children as rejecting and developmentally abnormal, either advanced or delayed. Separations and difficulties during reunions were critical. The fatality was not a one-time event, but the exit point of a recurrent cycle of abusive interaction.     

Depressive mood and social maladjustment: Differential effects on academic achievement

The Children Depression Inventory (CDI) is a multidimensional instrument that includes items of social withdrawal, anhedonia, asthenia, low self-esteem (internalized) and behavioral problems (externalized). Child depression has been related with low academic achievement, neurotic and introverted personality traits and social maladjustment defined by aggressiveness, psychoticism and antisocial behavior. In this work, it is hypothesized that in non-clinical populations, the relationships between CDI scores and a low academic achievement might be basically due to social maladjustment assessed by the behavioral items of this instrument, which do not necessarily tap depressive mood. The effects of both depressive mood and social maladjustment on academic achievement are analyzed in an adolescent sample of 315 boys and 363 girls through Structural Equation Modelling procedures. Results corroborate the hypothesis that social maladjustment measured by the CDI behavioral items and Psychoticism explain low academic achievement over and above depressive mood measured by the rest of the CDI items, extraversion and neuroticism.     

Maternal mental illness and the safety and stability of maltreated children

Objective

Children of mothers with mental illness are at risk for multiple untoward outcomes, including child maltreatment and foster care placement. The purpose of this analysis was to determine the association between maternal mental illness and children's long term safety and stability.

Methods

A multi-sector administrative dataset from the Department of Social Services (DSS) and Department of Mental Health (DMH) was analyzed. The sample was 4,895 low income families (mother and child dyads) first reported to child welfare in 1993 or 1994. Families were followed until March of 2009. Dates of new report and foster care placement were obtained from DSS data. ICD-09 or ICD-10 diagnostic codes were obtained from Department of Mental Health data. Schizophrenic disorders, episodic mood disorders, anxiety disorders and personality disorders were examined.

Results

New reports were more likely for children of mothers with mental illness, regardless of diagnosis. While overall 67% of children had a new report over the course of their childhood, rates ranged from 80 to 90% for children of mothers with mental illness and occurred within a shorter time frame than for other children. In the multivariate models, mood (HR = 1.41, p < .001) and anxiety disorders (HR = 1.32, p < .05) placed children at greater risk for new reports. The proportion of children with foster placements was more than double for children of mothers with mental illness than for other children. In the multivariate model, anxiety disorders were strongly associated with the risk of placement (HR = 1.75, p < .001).

Conclusions and Practice implications

Important differences in safety and stability were found between children of mothers with and without mental illnesses, as well as some variability across diagnoses. Since these mothers had already received services our findings suggest that access is not enough. The services they are receiving or have received may be an ineffective approach to helping them parent safely.